Tracheostomy complications in otorhinolaryngology are rare despite the critical airway

Purpose To identify complications of surgical tracheostomies in otorhinolaryngologic patients and adjust our processes to be properly prepared in the future. Methods We reviewed retrospectively all surgical tracheostomies (n = 255) performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017. Patient demographics, surgical details, surgical and medical complications, and tracheostomy-related mortality were recorded from the hospital charts. Risk factors for complications were assessed. Results Altogether, 55 (22%) complications were identified in 39 (15%) patients, with pneumonia, accidental decannulation, and bleeding being the most common. No patient or surgery-related factor reached significance in overall complication risk factor analysis. Medical complications were more common after elective tracheostomies compared to emergency procedures (10.6% vs. 3.5%, p <0.05). Majority of complications (78%) were classified as mild or moderate according to Clavien-Dindo. Only 2 (0.8%) tracheostomy-related deaths were recorded. Conclusion In otorhinolaryngologists service, severe complications and tracheostomy-related deaths are very rare. Reducing their prevalence even further with careful planning is possible.Peer reviewe

Migraine is not the most common comorbidity in hidradenitis suppurativa patients

Non peer reviewe

Type 2 diabetes mellitus in a cohort of Finnish patients with hidradenitis suppurativa

Non peer reviewe

Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center : a safe procedure with a wide spectrum of indications

PurposeTo review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist-head and neck surgeons in a single tertiary care center.MethodsSurgical tracheostomies performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between January 2014 and February 2017 were retrospectively reviewed. Patient demographics, surgical data, and peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18months.ResultsThe total population was 255, with a majority (n=181; 71%) of males. The majority of patients (n=178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9days (range 1-425). The surgical mortality was 0.4%.ConclusionSimultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two-thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy dependent for a prolonged period. Tracheostomy was found to be a safe procedure.Level of evidence2b.Peer reviewe

Complications in lymph node excision in the head and neck area

Background Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. Aims/Objectives This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. Materials and methods Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. Results The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. Conclusions and significance Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.Peer reviewe

Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist-head and neck surgeons : safe and efficacious

Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P <0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P <0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.Peer reviewe

Work-up of globus : assessing the benefits of neck ultrasound and videofluorography

Globus patients with normal ear, nose, and throat ( ENT) status are a diagnostic challenge. The symptom may be long lasting and cause concern about malignancy, leading to possibly unnecessary further investigation. The aim of the study was to assess whether radiological examinations are useful in globus diagnostics, how often patients suffer from persistent globus, and whether globus patients with normal ENT status develop a malignancy during a follow-up. We reviewed medical records of all 76 globus patients referred to Helsinki University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery in 2009. Patient history and findings in physical and radiological examinations were registered. A questionnaire concerning patients' present pharyngeal symptoms was sent 3 and 6 years after their initial visit. Data from the Finnish Cancer Registry revealed whether patients developed malignancies within a 3-year follow-up. Based on medical records, neck ultrasound was performed for 37 (49 %) and videofluorography for 22 patients (29 %), with nonsignificant findings. After a 3- and 6-year follow-up, half patients indicated that they were asymptomatic or had fewer symptoms, whereas the rest had persistent symptoms. The Finnish Cancer Registry data confirmed that globus patients developed no head and neck malignancies during a 3-year follow-up. In the present study, neck ultrasound and videofluorography showed no additional benefit to evaluate the globus etiology in patients whose ENT status was normal. Half the globus patients suffered from persistent symptoms after a 3- and 6-year follow-up, indicating that globus may cause discomfort chronically. However, no patients developed malignancies during a 3-year follow-up.Peer reviewe

Systematic review of tonsil surgery quality registers and introduction of the Nordic Tonsil Surgery Register Collaboration

Surgical quality registers provide tools to measure and improve the outcome of surgery. International register collaboration creates an opportunity to assess and critically evaluate national practices, and increases the size of available datasets. Even though millions of yearly tonsillectomies and tonsillotomies are performed worldwide, clinical practices are variable and inconsistency of evidence regarding the best clinical practice exists. The need for quality improvement actions is evident. We aimed to systematically investigate the existing tonsil surgery quality registers found in the literature, and to provide a thorough presentation of the planned Nordic Tonsil Surgery Register Collaboration. A systematic literature search of MEDLINE and EMBASE databases (from January 1990 to December 2016) was conducted to identify registers, databases, quality improvement programs or comprehensive audit programs addressing tonsil surgery. We identified two active registers and three completed audit programs focusing on tonsil surgery quality registration. Recorded variables were fairly similar, but considerable variation in coverage, number of operations included and length of time period for inclusion was discovered. Considering tonsillectomies and tonsillotomies being among the most commonly performed surgical procedures in otorhinolaryngology, it is surprising that only two active registers could be identified. We present a Nordic Tonsil Surgery Register Collaboration-an international tonsil surgery quality register project aiming to provide accurate benchmarks and enhance the quality of tonsil surgery in Denmark, Finland, Norway and Sweden.Peer reviewe

A Prospective Observational Study of Complications in 140 Sialendoscopies

Objectives. To evaluate the incidence and nature of complications associated with diagnostic and interventional sialendoscopies and to report intervention failures in a prospective setup. Study Design. Prospective observational study. Setting. Academic tertiary care university hospital. Subjects and Methods. Patients who underwent diagnostic or interventional sialendoscopy between October 2015 and December 2016 were prospectively enrolled. Patient data, operation-related factors, treatment failures, and complications were recorded into a database and analyzed. Results. A total of 140 sialendoscopies were attempted or performed on 118 patients; 67 (48%) were for a parotid gland and 73 (52%) for a submandibular gland. The sialendoscopy was interventional in 81 cases (58%), diagnostic in 56 (40%), and not possible to perform in 3 (2.1%). A total of 21 complications were registered for 21 sialendoscopies (15%) and 21 patients (18%). The most common complication was infection, in 9 cases (6.4%). Other observed complications were salivary duct perforation (4 cases), prolonged glandular swelling (3 cases), transient lingual nerve analgesia (2 cases), basket entrapment (2 cases), and transient weakness in the marginal branch of the facial nerve (1 case). All complications were related to interventional procedures or papilla dilatation. Failure to treat occurred in 21 (15%) sialendoscopies: sialendoscopy itself was unsuccessful in 3 cases, and an intended intervention failed in 18 cases. Conclusion. Complications in sialendoscopy are usually related to interventional procedures. The complications are mainly minor and temporary but lead to additional follow-up visits, further treatments, and sometimes hospitalization. Sialendoscopic procedures are safe but not free of complications.Peer reviewe

Kirurgiset komplikaatiot ja niiden rekisteröinti korva-, nenä- ja kurkkutautien erikoisalalla

The incidence of complications is one of the most commonly used outcome measure in surgery. Systematic registration of complications creates possibilities to monitor and improve quality of care, allows comparison between the treating units and provides tools for treatment decisions and patient education. Complication prevalence of three common procedures in Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) was evaluated to discover predisposing factors for complications, and to develop a feasible prospective registration system for surgical complications in ORL-HNS. Additionally, this pursuit of register development has resulted in Department of ORL-HNS, HUH, participation in the Nordic Tonsil Surgery Register Collaboration (NTSRC). Postoperative complications of tonsil surgery and comprehensiveness of prospective complication data recording was assessed in 573 patients. The overall complication rate was 13.8%, with secondary hemorrhage being the most common complication (9.6%). Altogether 69.6% of patients with a complication were identified in prospective data retrieval. The pitfalls of registration process were assessed. Procedure-specific incidences of complications after benign parotid surgery and predictive factors for the postoperative facial nerve dysfunction were evaluated in 132 patients. On the first postoperative day, 40.2% of patients had facial palsy. Palsy rates in the subgroups of extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and extended parotidectomy were 6.3%, 41.5%, 43.8%, and 53.8%, respectively. Age, duration of surgery and use of ultrasound knife were identified as independent risk factors for transient facial palsy. Third study evaluated the outcome of percutaneous endoscopic gastrostomy (PEG) inserted by ORL-HN surgeons and assessed the delays in comparison with earlier practice of referring the patients needing PEG to gastrointestinal surgeons. Four patients (3.2%) had a major complication. Peristomal granulomatous tissue was the most common minor complication (18.5%). Independence from gastrointestinal surgeons’ services reduced the time-delay and enhanced the availability of urgent PEG placements. The fourth study was a systematic literature review of tonsil surgery quality registers, and an introduction of the NTSRC, which is the first reported international register collaboration project within the specialty of ORL-HNS. The systematic review revealed five registries, quality improvement programs, or comprehensive audit programs with an inclusion principle of tonsil surgery. Two of them had ongoing activity. The three prospective studies acted as pilot projects for surgical complication registration at Department of ORL-HNS, HUH, and a long-term objective is to develop a systematic surgical quality register to our unit. One part of it is the tonsil surgery register, which features are more specifically discussed.Komplikaatioiden ilmaantuvuus on yksi käytetyimmistä kirurgian tulosmittareista. Komplikaatioiden systemaattinen rekisteröinti mahdollistaa hoidon laadun seurannan, toiminnan kehittämisen ja yksiköiden välisen vertailun, sekä antaa eväitä hoitopäätösten tekoon ja potilasohjaukseen. Pään ja kaulan alueen kirurgian komplikaatioiden kirjo on alueen monimuotoisen anatomian ja fysiologian vuoksi varsin erityinen, joten yleiskirurgiset komplikaatiorekisterit soveltuvat huonosti korva-, nenä- ja kurkkutautien (KNK) leikkauskomplikaatioiden seurantaan. Tavoitteena oli kartoittaa kolmeen HYKS KNK-klinikalla tavalliseen toimenpiteeseen liittyvien komplikaatioiden ilmaantuvuutta ja riskitekijöitä, sekä samalla kehittää käytännön työhön soveltuvaa komplikaatioiden seurantajärjestelmää. Sen yksi osa tulee olemaan nielurisakirurgiarekisteri, joka toimii osana pohjoismaista yhteisrekisteriä. Ensimmäisessä osatyössä kartoitettiin nielurisakirurgian komplikaatioita ja tutkittiin rekisteröintiprosessiin liittyviä ongelmakohtia. Komplikaatioita esiintyi 13.8%:lla 573:sta potilaasta. Kaikkiaan 69.6% komplikaatiopotilaista saatiin kiinni prospektiivisessa tiedonkeräyksessä, ja loput todettiin retrospektiivisessä tietojen tarkistuksessa. Prospektiiviseen rekisteriin oli kirjattu kattavimmin tavallisimmin ilmenevät komplikaatiot. Toisessa osatyössä tutkittiin korvasylkirauhaskirurgian komplikaatioita, ja pyrittiin tunnistamaan ennustetekijöitä postoperatiiviselle kasvohermohalvaukselle. Leikkauslaajuudesta riippuen kasvohermon toimintahäiriö havaittiin ensimmäisenä postoperatiivisena päivänä 6.3-53.8 %:lla potilaista. Riskitekijäanalyysin perusteella ikä, leikkauksen pidempi kesto ja ultraääniveitsen käyttö muodostuivat ohimenevän kasvohermohalvauksen itsenäisiksi riskitekijöiksi. Kolmannessa osatyössä arvioitiin KNK-lääkäreiden suorittamien perkutaanisten endoskooppisten gastrostoomaletkujen (PEG) asennusten tuloksia 127 potilaalla, ja arvioitiin PEG-asennuksen viiveaikoja verrattuna aiempaan toimintatapaan lähettää PEG:aa tarvitsevat potilaat vatsaelinkirurgian endoskopiayksikköön. Neljällä (3.2%) potilaalla ilmeni vakava postoperatiivinen komplikaatio. Lievistä komplikaatioista tavallisin oli stooma-aukon granulaatio (18.5%). Riippumattomuus vatsaelinkirurgien palveluista lyhensi PEG-asennuksen viivettä ja paransi kiireellisten asennusten saatavuutta. Kirjallisuudessa ei ole aiemmin kuvattu KNK-alan kansainvälistä laaturekisteriyhteistyötä. Neljännessä osatyössä arvioitiin systemaattisen kirjallisuuskatsauksen avulla nielurisakirurgian laaturekisterejä, ja kuvattiin pohjoismainen yhteisrekisteri kattaen alkuvaiheet, rekisteröitävät muuttujat ja kansalliset rekisterit. Yhteistyön tavoitteena on Ruotsin nielurisakirurgian laaturekisterin mallia noudattaen luoda vastaavat rekisterit muihin pohjoismaihin. Pohjoismainen yhteisrekisteri tarjoaa laajan potilasaineiston laadunvalvontatarkoituksiin, ja sillä on ilmeinen potentiaali nielurisakirurgian turvallisuuden parantamisessa ja standardoitujen hoitokäytäntöjen luomisessa